title: Long-term liposteroid therapy for idiopathic pulmonary hemosiderosis.
abstract: Control of refractory bleeding in idiopathic pulmonary hemosiderosis (IPH) is challenging. Based on the effect of liposteroid (dexamethasone palmitate) for acute bleeding in two reported cases, the long-term utility was assessed in all nine IPH children (including the first two cases) treated in a tertiary center for 20 years. The median at disease onset was 2.3 years (range, 1.2 to 8.6). All had life-threatening and/or repetitive bleeding on prednisolone (PSL) therapy. Liposteroid was intravenously infused at 0.8 mg/kg/day for three consecutive days at the time of acute bleeding. Single infusion was followed by a longer interval from weekly to monthly accompanied by low-dose PSL (less than 0.3 mg/kg/day). Monthly infusion as maintenance therapy was continued for prophylaxis of bleeding. Treatment outcomes were retrospectively analyzed. During the observation period of a median of 11.0 years (range 2.4-16.9 years), no one died. Five patients were weaned and the other one was being weaned from liposteroid for the cure or long remission (median, 5.5 years). Three others were on liposteroid therapy because of active disease. Neither patient had respiratory symptoms, although three showed subnormal %vital capacity. Serum levels of KL-6 and ferritin were normal in all and all but one patient(s), respectively. Four patients (three on liposteroid therapy) showed low bone mineral density. There were no obese patients. Height SD score did not significantly decrease except for one patient.
  
  
  CONCLUSIONS
  The liposteroid therapy might improve the survival of IPH patients with reducing the adverse effects of steroids, although prospective control studies are needed.
authors.affiliation: Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Doi
authors.forename: Shouichi
authors.initials: S
authors.lastname: Ohga
authors.forename: Masataka
authors.initials: M
authors.lastname: Ishimura
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Takada
authors.forename: Kanako
authors.initials: K
authors.lastname: Ishii
authors.forename: Kenji
authors.initials: K
authors.lastname: Ihara
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Nagai
authors.forename: Toshiro
authors.initials: T
authors.lastname: Hara
mesh_terms: D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006486:Hemosiderosis / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008081:Liposomes; D008171:Lung Diseases / Q000188:drug therapy*; D008297:Male; D008863:Microspheres; D012189:Retrospective Studies; D016896:Treatment Outcome; D000097545:Hemosiderosis, Pulmonary
chemical_list: D005938:Glucocorticoids; D008081:Liposomes; C035081:dexamethasone 21-palmitate; D003907:Dexamethasone